摘要
目的探究食管癌患者术前循环中胰岛素样生长因子-1(IGF-1)及其受体水平对术后营养风险的评估价值。方法选取2020年1月至2022年10月在南方医科大学珠江医院行食管癌切除术患者106例,采用营养风险筛查2002(NRS2002)对所有术后1年及以上的患者进行随访调查,根据NRS2002评分将营养风险情况分为营养风险组82例,其中男61例,女21例,年龄46~79(63.68±9.23)岁,评分≥3分,及无营养风险组24例,其中男18例,女6例,年龄45~80(62.87±9.59)岁,评分<3分。检测患者术前血中IGF-1、胰岛素样生长因子1受体(IGF-1R)及胰岛素样生长因子结合蛋白的表达水平,分析食管癌患者术后发生营养风险的影响因素,预测食管癌患者术后营养风险的价值。计量数据组间差异采用配对t检验或方差分析。结果营养风险组血中IGF-1、IGF-1R、胰岛素样生长因子结合蛋白-1(IGFBP-1)和胰岛素样生长因子结合蛋白-3(IGFBP-3)的mRNA水平低于无营养风险组(IGF-1:0.49±0.48比1.02±0.27,t=6.121,P<0.01;IGF-1R:0.58±0.39比0.99±0.21,t=9.108,P<0.01;IGFBP-1:0.52±0.29比1.00±0.18,t=10.336,P<0.01;IGFBP-3:0.62±0.31比0.99±0.12,t=5.857,P<0.05)。多因素logistic回归分析显示,IGF-1、IGF-1R水平降低是食管癌患者术后发生营养风险的危险因素[IGF-1:回归系数(OR)=0.626,95%置信区间(CI):0.225~0.968,P<0.05;IGF-1R:OR=0.511,95%CI:0.201~0.972,P<0.05]。受试者工作特征曲线(ROC)显示,循环中IGF-1/IGF-1R截断值为1.034,曲线下面积(AUC)为0.842(95%CI:0.789~0.896,P<0.01)。结论食管癌患者术前循环中IGF-1、IGF-1R水平降低是术后发生营养风险的危险因素,具有良好价值。
Objective To explore the evaluation value of the levels of insulin-like growth factor-1(IGF-1)and its receptor in the preoperative circulation of patients with esophageal cancer for the assessment of postoperative nutritional risk.Methods A total of 106 patients who underwent esophageal cancer resection at Zhujiang Hospital of Southern Medical University between January 2020 and October 2022 were enrolled.All patients were followed up for 1 year or more after surgery and evaluated using the Nutritional Risk Screening 2002(NRS2002).Based on NRS2002 scores,patients were divided into a nutritional risk group[82 cases:61 males,21 females;aged 46-79 years,mean age(63.68±9.23)years;NRS2002 score≥3]and the non-nutritional risk group[24 cases:18 males,6 females;aged 45-80 years,mean age(62.87±9.59)years;NRS2002 score<3].Preoperative blood levels of IGF-1,IGF-1R,and insulin-like growth factor binding proteins(IGFBPs)were measured.Risk factors for postoperative nutritional risk in esophageal cancer patients were analyzed,and the predictive value of these biomarkers for postoperative nutritional risk was evaluated.Differences in categorical data between groups were analyzed using paired t-tests or analysis of variance(ANOVA).Results The mRNA levels of IGF-1,IGF-1R,IGFBP-1,and IGFBP-3 in the blood of the nutritional risk group were significantly lower than those in the non-nutritional risk group(IGF-1:0.49±0.48 vs.1.02±0.27,t=6.121,P<0.01;IGF-1R:0.58±0.39 vs.0.99±0.21,t=9.108,P<0.01;IGFBP-1:0.52±0.29 vs.1.00±0.18,t=10.336,P<0.01;IGFBP-3:0.62±0.31 vs.0.99±0.12,t=5.857,P<0.05).Multivariate logistic regression analysis showed that the decreased levels of IGF-1 and IGF-1R were risk factors for postoperative nutritional risk in patients with esophageal cancer[IGF-1:regression coefficient(OR)=0.626,95%confidence interval(CI):(0.225-0.968),P<0.05;IGF-1R:OR=0.511,95%CI:(0.201-0.972),P<0.05].The receiver operating characteristic(ROC)curve showed that the cut-off value of IGF-1/IGF-1R in the circulation was 1.034,and the area under the curve(AUC)was 0.842(95%CI:0.789-0.896,P<0.01).Conclusion Decreased levels of IGF-1 and IGF-1R in preoperative circulation are risk factors for postoperative nutritional risk in patients with esophageal cancer,and have good value.
作者
余艳
张小红
张福伟
吴源周
冯靖
Yu Yan;Zhang Xiaohong;Zhang Fuwei;Wu Yuanzhou;Feng Jing(Department of Thoracic Surgery,Zhujiang Hospital of Southern Medical University,Guangzhou 510282,China)
出处
《中华实验外科杂志》
2025年第7期1375-1377,共3页
Chinese Journal of Experimental Surgery
关键词
食管癌
营养风险
手术后
胰岛素样生长因子1
Esophageal cancer
Nutritional risk
Postoperative
Type 1 insulin-like growth factor
